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    "title": "Tobacco Effective National Action to Control Tobacco (ENACT) [2]",
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        "Records of the Domestic Policy Council (Clinton Administration)",
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    "ocrText": "reimbursement for services and treatment;\neducation and training of service providers;\nresearch and evaluation of pharmacological devices and counseling techniques.\nENACT believes that no tobacco user should encounter financial barriers in seeking effective\ntreatment for his or her nicotine addiction and that the first priority be placed on those\npopulations which do not currently have access to tobacco use treatment programs. ENACT\nrecommends that tobacco use treatment and counseling be covered benefits under the Medicare\nand Medicaid programs, financed by the tobacco industry. Veterans Administration Medical\nCenters should provide cessation treatment for every veteran requesting assistance. Other\nfederally financed health providers such as Community Health Centers and state and local public\nhealth providers should assure access to tobacco cessation programs on a contract basis if\nservices are not provided on clinic premises. ENACT also encourages that reimbursement\ncontinue to be provided and further expanded by the health insurance industry so that cessation\ncounseling and treatment can be arranged for by all managed care organizations for the managed\ncare patient population as well as by the private practitioner to individual patients.\nENACT supports the accepted tobacco use treatment methods as outlined in the 1996 Agency for\nHealth Care Policy and Research (AHCPR) Clinical Practice Guideline on Smoking Cessation,\nand recommends that grant recipients who develop and administer such programs mirror these\nand/or other similar evidence based guidelines. AHCPR's cessation guidelines recommend that\nclinicians record the tobacco-use status of every patient and offer smoking cessation treatment to\nevery smoker at every office visit. Any national cessation effort must ensure that health care\nsystems are doing everything they can to identify and intervene with tobacco users. A\nmechanism must be established that will continue to update guidelines as new research becomes\navailable regarding tobacco use treatment methods. Furthermore, outreach to clinicians must\ncontinue as new therapies become available.\nIn order to carry out AHCPR's guidelines successfully, ENACT believes that a public health\ninfrastructure is needed to ensure the accessibility and availability of tobacco use treatment.\nThrough grants to health professions schools and primary care residency programs, the Health\nResources and Services Administration (HRSA) in conjunction with the Centers for Disease\nControl and Prevention (CDC), should be responsible for the training and education, including\ntechnical assistance, of current and future health care professionals including instruction\nregarding environmental tobacco smoke, prevention of youth access, and changing public policy\nand social norms. Funding for activities such as the development of medical, residency and\ncontinuing medical education curriculums which address tobacco use prevention and cessation,\nfaculty development, and residency training in the area of nicotine addiction counseling,\ntreatment and prevention to all populations should be components of such grants. Special\nemphasis on outreach and treatment to youth, women, underserved and minority populations\nshould be considered, especially as new and possibly more costly medications become available."
}